Impact of Socioeconomic Status on Cardiovascular Disease and Mortality in 24,947 Individuals With Type 1 Diabetes Featured Article: Araz Rawshani, Ann-Marie Svensson, Annika Rosengren, Björn Eliasson, and Soffia Gudbjörnsdottir Diabetes Care Volume 38: 1518-1527 August, 2015

STUDY OBJECTIVE   To examine the association of socioeconomic status (SES) with cardiovascular disease (CVD) and death in a large cohort of patients with type 1 diabetes Rawshani A. et al. Diabetes Care 2015;38:1518-1527

STUDY DESIGN AND METHODS Clinical data from the Swedish National Diabetes Register were linked to national registers to obtain information on the following: Income Education Marital status Country of birth Comorbidities Events Patients were followed until a first incident event, death, or end of follow-up Association between socioeconomic variables and the outcomes was modeled using Cox regression Rawshani A. et al. Diabetes Care 2015;38:1518-1527

RESULTS Patients included 24,947 individuals with mean (SD) age and follow-up of 39.1 (13.9) and 6.0 (1.0) years Death and fatal/nonfatal CVD occurred in 926 and 1,378 individuals Compared with being single, being married was associated with 50% lower risk of death, cardiovascular (CV) death, and diabetes-related death Rawshani A. et al. Diabetes Care 2015;38:1518-1527

RESULTS When compared with individuals in the highest income quintile, those in the two lowest quintiles had: Twice as great a risk of fatal/nonfatal CVD, coronary heart disease, and stroke Roughly three times as great a risk of death, diabetes-related death, and CV death Individuals with a college/university degree had 33% lower risk of fatal/nonfatal stroke Immigrants had 19%, 33%, and 45% lower risk of fatal/nonfatal CVD, all-cause death, and diabetes-related death, respectively, compared with Swedes Men had 44%, 63%, and 29% greater risk of all-cause death, CV death, and diabetes-related death Rawshani A. et al. Diabetes Care 2015;38:1518-1527

Rawshani A. et al. Diabetes Care 2015;38:1518-1527

Rawshani A. et al. Diabetes Care 2015;38:1518-1527

Data are crude baseline values as means 6 1 SD unless otherwise indicated. BP, blood pressure; Chol-to-HDL ratio, total cholesterol–to–HDL ratio; IHD, ischemic heart disease. aCohabiting as registered partners. Rawshani A. et al. Diabetes Care 2015;38:1518-1527

Figure 1—Adjusted HRs for CV events among patients with type 1 diabetes. Two models were computed for each outcome. The minimally adjusted models were identical for each outcome and controlled for age, sex, immigrant status, and duration of diabetes. Fatal/nonfatal CVD was additionally adjusted for smoking, systolic blood pressure, HbA1c, exercise level, eGFR, albuminuria, total cholesterol–to–HDL ratio, antihypertensive medications, statins, and aspirin. Fatal/nonfatal CHD and fatal/nonfatal stroke were adjusted for the same covariates. Note that the category “married” includes individuals who were cohabiting (registered as partners). educ., education. Rawshani A. et al. Diabetes Care 2015;38:1518-1527

CONCLUSIONS x Rawshani A. et al. Diabetes Care 2015;38:1518-1527

Figure 2—Adjusted HRs for death from any cause and death from specific causes among patients with type 1 diabetes. Two models were computed for each outcome. The minimally adjusted models were identical for each outcome and controlled for age, sex, immigrant status, and duration of diabetes. All-cause death and CV death were additionally adjusted for smoking, HbA1c, exercise level, eGFR, CVD, albuminuria, and HF. Diabetesrelated death was additionally adjusted for smoking status, systolic blood pressure, HbA1c, exercise level, eGFR, chronic kidney disease, and albuminuria. Note that the category “married” includes individuals who were cohabiting (registered as partners). educ., education. Rawshani A. et al. Diabetes Care 2015;38:1518-1527